Individual
DR. MICHAEL T MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD19293
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
003335018
REGENCE BLUE CROSS OF OR
OR
05
—
071704
—
OR
01
—
110187067
RAILROAD MEDICARE/PALMETT
OR
Enumeration date
11/01/2006
Last updated
05/27/2008
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